Traditionally, guitar picks used to pluck the strings of a guitar are flat and generally teardrop shaped. The pick is held by a player between his/her thumb and index finger at the wide end wherein the strings are plucked with the tip at the thinner more pointed end.
Generally speaking, it is desirable to contact the strings of a guitar such that the plane of the pick is parallel to the direction of the string. To accomplish this, a player may need to bend his/her wrist unnaturally can cause wrist fatigue and may contribute to joint and connective tissue damage in the wrist over time.
Several different pick designs have been proposed through the years. Generally, these alternative pick designs maintain the elongated tear drop shape but twist and/or bend the pointed string-plucking tip such that a player can at least theoretically hold the pick more naturally. Interestingly, the twisted design forces many players to hold these picks farther back on the wide end increasing the distance from the players thumb and the plucking tip. Ostensibly for many players especially those who prefer to choke up on a pick, it is difficult to easily and quickly find a comfortable position to hold these picks.